The bacterium Mycoplasma genitalium was isolated for the first time in 19801
There is increasing evidence that the bacterium can cause urogenital symptoms and infection
The bacterium is also found in asymptomatic individuals
occurrence
The prevalence of Mycoplasma genitalium depends on the population under study:
In a South African study screening among 21-23 year-old men and women were found the prevalence of M.genitalium in women to 2.3% (21/921) in men and 1.1% (8/731)2
In a Swedish study from a Venereology clinic found a high incidence of M.genitalium in male patients who presented with persistent or recurrent symptoms of urethritis, after being treated with doxycycline from microscopically verified non-gonorrhoisk urethritis, so 32 / 78 (41%)3
Etiology and pathogenesis
The bacterium is found intracellularly and are very difficult to grow
Different from other bacteria by the lack of a cell wall; This makes it insensitive to penicillins and cephalosporins
An increasing number of studies demonstrating a strong association between M. genitalium and non-gonorrhoisk urethritis (NGU), and especially non-chlamydia NGU (NCNGU) in men and cervicitis in females, as well as an association between endometritis and M.genitalium in women4
There is evidence that M. genitalium is transmitted through sexual transmission, including high concordance of M.genitalium genotypes in infected couple
More patients with M.genitalium have symptomatic urethritis than asymptomatic urethritis
Co-infection with Chlamydia trachomatis is not frequent
predisposing factors
Sexual intercourse with infected person
ICPC 2
U72 Urinrørsbetændelse
X74 Pelvic inflammatory disease
ICD-10
N34 Urinrørsbetændelse and uretrasyndrom
N341 Infectious urethritis UNS
N342 Other types of urethritis
N343 urethral syndrome UNS
N370 urethritis v disease KA
Diagnosis
diagnostic criteria
Positive PCR for Mycoplasma genitalium
The bacteria are difficult to grow
In practice, the diagnosis is often the symptoms and exclusion of differential diagnoses:
Pain during urination and possible urethral discharge in men and women; possibly slightly increased vaginal discharge in women
Negative PCR test for Chlamydia trachomatis and possibly also negative testing for gonorrhea
Differential
chlamydia
gonorrhea
Non-specific urethritis for another reason
Medical history
in men
Urethritis with dysuria and / or discharge
Chronic or recurrent urethritis seen in patients who initially for non-gonorrhoisk urethritis have been treated with an inadequate acting antibiotics to M.genitalium
It is unclear to what extent M. genitalium is the cause of complications such as epididymitis, prostatitis and reactive arthritis
in women
Urethritis and cervicitis with dysuria and vaginal discharge
There is increasing studies suggest an association between M.genitalium and pelvic inflammatory disease in the form of endometritis and / or salpingitis
It is not clear whether, and to what extent, infection with M.genitalium in women is associated with infertility
clinical findings
Any urethral or vaginal discharge
Additional studies in general practice
Chlamydia PCR test and the detection of gonorrhea
Mycoplasma test
Urine and cervical or vaginal. The urine sample is given not more than 2 hours after final urination and collected in sterile glass tip.
Where urine samples are not available urethral swab (eSwab)
The PCR test is the only relevant diagnostic testing to detect M. genitalium ; this is available at Statens Serum Institut, either as single study or in combination with PCR for C. trachomatis and Ureaplasma urealyticum
indication
Patients with symptoms and discomfort of urethritis / cervicitis
Contacts of infection in patients with established infection
Treatment
Treatment goals
Elimination of the microbe
Generally about the treatment
Clinical experience and studies have shown that azithromycin has better effect than doxycycline and erythromycinfor eradication is of M. genitalium3But once dose azithromycin has been shown to induce resistance in a number of cases with urethritis5
Verified by microscopic non-gonorrhoisk urethritis, and in response to studies become available, which is treated with tabl. doxycycline100 mg x 2 for 7 days in order to reduce the risk of developing azithromycinresistens relative to M.genitalium
Medical treatment
azitromycin:
azitromycin 500 mg x 1 first day of treatment and 250 mg x 1 for the subsequent four days5
Detected by mutation, ie azithromycinresistens:
moxifloxacin 400 mg x 1 for 7 days
Course, complications and prognosis
Progress
Commonly is acute urethritis, but it has been documented that the condition may be chronic or recurrent
complications
Epididymitis and prostatitis?
Can lead to endometritis / salpingitis, and thereby chronic pelvic pain and possibly reduced fertility
Forecast
Good with proper treatment
Follow-up
After Checking with new urine sample or urethrapodning and cervical or vaginal should be done 4-5 weeks after treatment
